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A live simulcast from the EMS Today 2018 conference, sponsored by Bound Tree, offered insight to attendees on how to prepare their communities to handle the most likely injury from an active shooter or mass casualty incident – severe hemorrhage.

The Stop the Bleed initiative was designed to provide bystanders with the tools and knowledge to provide immediate and effective hemorrhage control. Bleeding control kits should be placed next to AEDs in order for both to be associated with the ability to save lives. (image/Bound Tree)

Rogers provided a firsthand account of the deadliest mass shooting in U.S. history – the Oct. 1, 2017 Las Vegas shooting. A gunman who opened fire on a crowd of concertgoers at the Route 91 Harvest music festival left 58 people dead and 851 injured.

Rogers described how imperative bystander support was during the shooting, with many helping to control victims’ severe hemorrhaging. There was also applause for the EMS crew members from Las Vegas, who were invited to attend the conference and were sitting in the first two rows during the presentation.

Medical adviser Hunt stressed the importance of the Stop the Bleed initiative, which was launched by the White House in October 2015. The national initiative was designed to provide bystanders with the tools and knowledge to provide immediate and effective hemorrhage control. The goal of the initiative is to empower the general public to be aware of the steps that can be taken to stop or slow life-threatening bleeding and to promote public access to bleeding control kits.

Goddard, the paramedic, explained how Arkansas secured funding to implement a statewide Stop the Bleed program, which involves EMS, police, school nurses, teachers and groups trained as "first first responders."

Memorable quotes on the importance of bleeding control

"Bystanders wanted to help. Those that were not injured were asking, ‘What can we do to help you?’ We went through all of our commercially available type of equipment, all of our C-A-T tourniquets and gauze." – Brian Rogers

"They [the crews] were cutting up stethoscopes and handing them to people and saying, ‘Here, make a tourniquet.’ They were packing wounds. There was nothing official about what we did. It had nothing to do with ‘Stop the Bleed,’ but it sure mimicked it." – Brian Rogers

"I was gratified to hear, when I was in Las Vegas learning about the challenges and profound successes they had that night, the concept of throw kits where you take an individual kit and throw it to a member of the general public who wants to help." – Richard Hunt

"If a voice inside a box can instruct someone to deliver a lifesaving electric shock, that same voice should be able to help someone stop the bleed." – Richard Hunt

"The expectation is when you call 911, you – the paramedic – are going to show up and solve all the problems. The weakness of our system is that we’re not always there in the first zero to 10 minutes when the cardiac arrest has occurred or life-threatening hemorrhage has occurred." – Major Clayton Goddard

"It’s these large mass casualty incidents that draw our attention, but all of us are faced with an imbalance between capability and capacity." – Major Clayton Goddard

Top takeaways on bleeding control kits, bystander assistance

Here are some of the other key takeaways from the presentation:

Locate bleeding control kits with visual and/or audio training next to AEDs.
Hunt said all bleeding control kits should be placed next to AEDs in order for both to be associated with the ability to save lives. An AED can deliver audio training to those using the device, but the kits cannot. Hunt stressed the importance of both audio and visual training for bleeding control kits due to how vital visual cues are for tourniquet application.

Engage bystanders from the very beginning.
Goddard mentioned a major flaw and weakness in most EMS systems: not utilizing a bystander on scene for help. "Lines have been drawn in our response system," Goddard said. "There’s nothing in your policy or procedure that you can’t utilize a bystander, but you hear FTOs saying, ‘Oh, they tend to get in the way; we don’t need them today.’" In order to save lives, he said, the lines must be redrawn in response systems.

Develop a statewide trauma system to help minimize preventable death.
In 2014, Goddard initiated a statewide effort to minimize death due to trauma. The state of Arkansas applied the principles of the U.S. military’s Tactical Combat Casualty Care training to law enforcement agencies, as well as public and private schools in the state. As a result, more than 3,000 state and local law enforcement officers became certified in tactical emergency casualty care, and more schools began actively participating in the Stop the Bleed program. Additionally, Swanson coordinated grant resources to provide each with individual first aid kits.

About the author

Sarah Calams previously served as Associate Editor of EMS1. In addition to her regular editing duties, Sarah delved deep into the people and issues that make up the EMS industry to bring insights and lessons learned to EMS providers everywhere.

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